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Indigenous and Tribal Peoples ConventionILO Convention no.169 – 1989 - Article 25 about Health1. Governments shall ensure that adequate health services are made available to the peoples concerned, or shall provide them with resources to allow them to design and deliver such services under their own responsibility and control, so that they may enjoy the highest attainable standard of physical and mental health.2. Health services shall, to the extent possible, be community-based. These services shall be planned and administered in co-operation with the peoples concerned and take into account their economic, geographic, social and cultural conditions as well as their traditional preventive care, healing practices and medicines.3. The health care system shall give preference to the training and employment of local community health workers, and focus on primary health care while maintaining strong links with other levels of health care services. Ole Mathis Hetta,

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Pitfalls --- Fallgruber 2 An important Sámi core value is to  En av de viktigste kjerneverdier i be self-reliant. This is learnt from samisk tenking og oppdragelse er ”ieš- early childhood through the biergejupmi” – å klare seg selv. Derfor upbringing process. As a result skjer det at mange samiske pasienter many Sámi will not seek help and søker helsehjelp mye seinere enn health care as early as advisable. ønskelig. Being silent to a proposal does not  ”Den som tier samtykker” er helt feil i mean agreeing in Sámi context. samisk kontekst. Consultations by traditional  Bruk av tradisjonelle healere/ practitioners is more common than helbredere er vanligere enn i among the majority population. befolkningen for øvrig. There are considerable differences  Det er store forskjeller i oppfattelsen in world view and understanding of av helse og sykdom blant samer and health and disease compared to the majoritetsbefolkningen majority population. 21.12.2011 Ole Mathis Hetta

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Case 1bAn old Sámi man was admitted to a local hospital for En eldre same ble innlagt på et lokalsykehus fordiagnostics and observation of a bad cough. observasjon og diagnostisering pga alvorlig hoste. AltEverybody on the health care side were concerned helsepersonell fryktet TB som kunne smitte tilabout him having TB that could be transmitted to andre. Han var svært urolig på sykehuset ogother people. He was very restless and wandered vandret omkring og ville slett ikke være på rommetaround and would not stay in the room he was given. som han hadde fått anvist. På den tredje dagen etterOn the third day after he had not slept for 2 nights, at han ikke hadde sovet de siste 2 nettene, var hanhe started to become confused and aggressive. An forvirret og aggressiv. En eldre samisk sykepleierelder Sámi nurse asked the man why he would not spurte han hvorfor han ikke ville sove, hvortil hansleep. He answered that he could not find his svarte at ikke kunne finne sin soveplass.restingplace. The nurse got hold of a reindeer-skin Sykepleieren fikk tak i et reinskinn som hun la overthat she put on top of a madrass on the floor in the en madrass på rommet og fjernet sykehussengen.room and removed the hospitalbed. The man Mannen gikk og la seg og sov i timevis og klarnetimmediately got down on the skin and slept for opp.hours and cleared up. 21.12.2011 Ole Mathis Hetta

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Case 1c ”Meahccastan-terapija” =”Out-in-the-nature therapy” ”Utmarks-terapi”Sami men are often not talkative in therapy- Samiske menn har en tendens til å bli svært stille og siersituations, they rather keep silent and close their ikke meget i terapisituasjoner, lukker seg inne.mouth and mind. For å bøte på dett har SANKS (Samisk nasjonaltIn order to overcome this situation SANKS kompetansesenter psykisk helse) utviklet en(Sami National Centre for Mental Health) have behandlingsmodell kalt Meahccastan-terapija,developed the concept ”out in the nature (Utmarks-terapi) hvor scenen for samtale og behandlingtherapy” – the scene for psychiatric treatment is flyttes fra et kontor eller behandlingsrom ut i naturen,not an office or a therapy-room, but out in under åpen himmel eller et telt.nature – under open sky or in a tent. They move En flytter ut i en situasjon hvor den ”samiske mannen”to a scene where the man masters the common normalt kan vise sine mestringsevner, og der er det ogsåchallenges and will be able to talk also about lettere å snakke om hverdagslige ting, men også ompersonal matters. This is used in treatment of problematiske temaer.psychiatric patients, in family therapy and Dette er brukt i behandlingen av psykiatriske problemer,alcohol and drug addicted patients in primary innen familieterapi, alkohol- og stoffavhengighet både icare and specialistcare. primær og i spesialisthelsetjenesten. 21.12.2011 Ole Mathis Hetta

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Case 3aThe municipal medical officer in a Saami Kommunelegen i en samiskmunicipality in Northern Norway denies kommune benekter at det erthat he can notice any cultural differences kulturforskjeller mellom dein his medical practice between the Saami samiske innbyggerne og de norske innflytterne iinhabitants and the others. legekonsultasjoner. SamtidigAt the same time he tells that he sier han at han opplever sværtexperiences the Saami patients as being mange av de samiskevery odd, not communicative and having pasientene som sære, som litevery high expectations about what he åpne og ofte med altfor store krav og forventninger til hvashould do for them. han kan hjelpe dem med. 21.12.2011 Ole Mathis Hetta

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Case 3bA young Sámi woman was given En ung samisk kvinne ble satt på antipsykotiskantipsychotic drugs by a psychiatrist after behandling av en psykiater etter at hun haddeshe had told him about her dreams. She fortalt han om sin drøm. Hun fortalte at huntold him that she had dreamt about an hadde drømt om at en ulykke kom til å hende,accident that was going to happen in near og hadde i drømmen fått vite hvem som kom tilfuture and that she in the dream told whowould be killed in that accident. Her å omkomme i ulykken. Hun fortalte at hennesgrandmother had come to her in the bestemor hadde kommet til henne og advartdream and warned her. Only about a week henne i drømmen.after her dream a snowmobile accident Bare en uke etter drømmen skjedde enkilled her brother and her boyfriend; she snøscooterulykke hvor hennes bror og kjærestewas pregnant with his child. After thisincident she was having a lot of self- omkom ,og hun var gravid med hans barn. Etterreproach for failing to prevent the ulykken hadde hun mye selvbebreidelser fordiaccident. She had no other psychotic hun ikke hadde klart å forhindre ulykken. Hunsymptoms or signs beside of telling about hadde ingen andre tegn på psykisk sykdom ennher dream. denne drømmen. 21.12.2011 Ole Mathis Hetta

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Tjenester for mindretalls- og flertallsbefolkning Minority and majority careEqual services may on the Like helsetjenester kan påsurface be alike, but in overflaten synes å være likereality not suited for the gode, men er i virkelighetenSámi. They are not knapt brukbare for denequivalent when they are samiske befolkningen. De ernot adapted to Sámi culture ikke likeverdige uten å væreand Sámi living conditions, tilpasset samisk kultur,and Sámi language is not samisk virkelighetsoppfatningused in communication with og levekår og kommunisertthe patients. In this way på samisk.they do not reach toeveryone equally. Ole Mathis Hetta,